Trigger foods can play key role in causing migraines


Rhonda Cadle loves pepperoni, but she has given it up for good.

Pamela Yeager used to savor the veal paprikash served at a local restaurant but now avoids it at all costs.

These women gave up foods they loved not because of calories, cholesterol or fat. Instead, they gave up foods that they realized, after some detective work, were almost sure to trigger headaches.

Certain foods and substances, such as caffeine and MSG, are common migraine triggers, but not all trigger foods prompt headaches among all migraine sufferers. This is because headache food triggers vary among individuals, and also because other factors, such as stress, hormone and weather changes, fatigue and hunger, can also raise the threshold that might trip a migraine. Because there can be so many contributing factors, doctors can find headaches notoriously difficult to treat.

“Migraines are generally not prompted by a single food or other environmental element, but doctors often underestimate foods as a risk factor,” said Dr. Roger Cady, vice president of the National Headache Foundation and director of the Headache Care Center in Springfield, Mo.

Finding the Connection

Further, many people don’t connect what they eat and drink with their pounding headaches.

“It would be logical to think that a trigger food would cause a headache every time you ate or drank it, but that’s not the case,” said Dr. David Buchholz, associate professor of neurology at Johns Hopkins and author of “Heal Your Headache.” “There are also many potent nondietary triggers, including stress, weather and hormonal changes, hunger and fatigue, that pile on the layers that lead to migraine. If the total trigger level is low, you’ve got a wider margin of error with your diet.”

To help patients figure out just what is causing their migraines, both Cady and Buchholz encourage their patients to keep a headache diary. Cadle, who is Cady’s patient as well as the research coordinator in his clinic, did just that.

“The migraines were running my life,” said Cadle, 42, a registered nurse who used to get migraines about twice a week, each of which could last for up to three days.

Cadle used her diary to track her activities and food intake for the previous 24 hours, noting what she ate, her stress level, odors she may have been exposed to, the weather and her hormonal cycle. She also noted what medication she took for the headaches.

Lowering the Risk

It took a few months to see the pattern, but eventually Cadle realized that her risk factors included many nonfood triggers, including changes in weather, stress levels and hormonal fluctuations. Because many of her triggers were unavoidable, Cadle tried to keep her overall headache threshold level low by drinking enough water, getting enough sleep and avoiding the foods and food additives that could prompt headaches, such as MSG and onions. She also learned to take headache relief medication at the first signal of an impending headache for maximum relief. Since taking these steps, Cadle has cut her migraine rate by about half, to roughly four per month.

Yeager’s relief has been even more dramatic. When she began tracking her headaches carefully, Yeager identified several risk factors, including certain perfumes, flashing or fluorescent bulbs and extreme hunger. But her biggest triggers were hormonal changes and foods, including red wine, smoked cheeses and meats, red dyes and dark chocolate, plus MSG.

From more than 100 migraines a year, Yeager, 43, now gets only about four. She’s given up on Cajun food but won’t give up Chinese and only goes to restaurants where she is sure that MSG won’t be hiding in her food.

Buchholz is not surprised by the women’s success. He believes that nearly all migraine sufferers can benefit by first cutting as many known headache trigger foods from their diets as possible and then adding them in one at a time until the problem foods are identified.

The Cold Turkey Approach

Buchholz recommends cutting them all at once, as opposed to one at a time, because food triggers are also inconsistent, leading many people to deny the food-headache connection.

“Headache sufferers often convince themselves that some of the foods they love don’t contribute to their headaches, either because the foods don’t always trigger a headache or because the headache comes a day after the food was eaten, when they assume it would have been immediate,” he said.

In fact, a headache may not erupt until a full 24 hours after eating a problem substance.

Buchholz believes that caffeine might be the top dietary headache trigger, yet people are fooled into thinking it’s a help, not a hindrance.

“Caffeine helps temporarily to relieve headaches because it constricts the blood vessels, but the rebound effect of those blood vessels expanding again contributes to more headaches in the long run,” he said. “When people get withdrawal headaches from stopping caffeine, they may think their headaches are caused by caffeine deprivation, and that reinforces the wrong idea.”

Painful as it is for our caffeine-addicted culture, Buchholz recommends that chronic headache sufferers quit caffeine completely, either by going cold turkey (and toughing out the withdrawal headaches that may follow) or cutting it down and then out within two weeks. This includes eliminating headache medications containing caffeine, such as Excedrin.

After caffeine, Buchholz’s list of the most potent headache trigger foods are dark chocolate (milk chocolate isn’t as bad since it has less cocoa, and white is OK), MSG (which can be hidden by other names, including hydrogenated vegetable protein and “seasonings”), processed meats and fish, cheese and other dairy products, nuts and nut butters, alcohol (especially red wine) and most vinegars, citrus and dried fruits, though even bananas are triggers for some people.

The artificial sweetener aspartame, which goes by the brand name Nutrasweet, is often a trigger for children, as well as adults. Last on the list are vegetables such as pea pods, lentils and other beans and brown onions. Sauerkraut can also be a trigger.

Buchholz acknowledges that it is unclear why certain foods will trip the migraine switch in headache sufferers, but that trigger foods, when added to other nondietary triggers, stack the deck, and migraines can result. He also acknowledges that the list of potential trigger foods is daunting, and that nobody can avoid every one.

But it’s not a life sentence, either.

“Eliminating these foods is a golden opportunity to learn to control and heal your headaches,” he said. “And after slowly adding foods back in, most people will end up with a small, manageable list of foods to avoid. This can potentially lower the dietary trigger by 90 percent.”

And that means a lot fewer headaches and a lot of life restored to migraine sufferers.

As Cadle observed: “The best thing you can do about migraines is to learn to prevent them. That way, you take charge of them instead of them taking charge of you.”

Judy Gruen’s latest book is “The Women’s Daily Irony Supplement.” She has written for the Los Angeles Times, Ladies’ Home Journal, Family Circle and Natural Solutions, where this article first appeared. Read more of her work on www.judygruen.com.

Helping Your Parent Defeat Depression


Sally H., an 80-year-old Fairfax resident, recently fell into inconsolable sadness after her canary died. To her family, her intense and prolonged sorrow seemed out of place because Sally had only bought the pet a few months earlier.

“It was only a bird!” they said.

What her family didn’t realize was that the loss of her canary reawakened decades of unfinished mourning.

For most people, disappointments or worries can trigger the mildest form of depression commonly called the “blues” or the “blahs.” These gloomy moods often respond to simple interventions, departing as quickly and sometimes as mysteriously as they arrived. Not so with grief — the overwhelming sorrow
that accompanies the death of a spouse or a beloved pet, or a decline in health. Usually, over time, grief gradually diminishes. The mourner experiences shorter periods of intense feelings alternating with longer periods of better mood, but it may take a year or more before the worst is over.

For elderly people, mild disappointments and grief can set off depression. According to estimates from the National Institute of Mental Health, nearly 750,000 older Californians suffer from depression each year. Put in another way, 50 percent of all seniors will endure a depression at some
point in their later years.

Depression can affect the entire family — but the family can also help intervene.

Washing the Blues Away

Engaging mom or dad in activities that they enjoyed in the past can often shoo away — or at least speed up — the demise of the blahs. A simple thing, like arranging a visit from a favorite grandchild or a close friend, can be effective, too.

You might try appealing to your parent’s “child within” by preparing a bubble bath or reading to him her, or putting on an old slapstick comedy and making popcorn for you to share. Inviting a senior who is in a funk to help you with your gardening, dish drying or sorting socks allows him or her
to contribute to the upkeep of the household while being distracted from his or her own low feelings.

Research demonstrates that mild or moderate exercise also has depression-lifting benefits.

Managing Grief

When the death of a loved one is the reason for the sadness, acknowledge the loss in as many ways as possible. Call frequently, send notes, visit and honor the departed with donations or memorials. Mention the deceased, recalling his or her special moments and pleasing personality traits. Talking
lessens the pain. Understand that your parent’s anger (directed at clergy, the doctor, God, the rescue teams and you) is likely to be a only a temporary stage in the grieving process. Don’t take it personally or argue about it.

Encourage your parent to find solace in spiritual, cultural, and religious practices. Provide extra attention during the anniversaries, birthdays and holidays that fall during the first year after the loss. Don’t discourage crying or suggest that she “ought to be over it by now!” Comments
like: “At least he’s not suffering any more” or “At least he lived a long life” do not help. Instead of saying “Call me if I can do anything,” make specific offers, such as “Can I pick up the groceries or cook dinner tonight?”

It’s extremely helpful to tell your grieving parent that anyone in the same position would be in similar emotional pain.

Healing Through Reminiscence

The older people get, the more time they spend reflecting on the past. This is a good and healthy thing to do. Reminiscence brings the past into the present and reminds an older person that he isn’t just an old man — he’s been a father, a businessman, a teacher and a darn good golfer. He is
loved and admired.

Should the remembering be filled with sorrow or regret, remind your mother that she probably did the best she could with what she had available at the time.

You can foster positive reminiscence by suggesting that your parent record his or her memories in a journal.

Work together on a scrapbook with photos, newspaper clippings, letters, postcards, greeting cards, sketches and poetry.

Create a video or audio recording of stories highlightingall of your father’s accomplishments and happiest moments.

Healing Through Igniting Interest in Others

Jim W., a 75-year-old widower who lives in the San Fernando Valley, struggled with depression for years, until he got all fired up about the city’s plan to bring down a half-dozen magnificent old trees. He quickly became too busy organizing sit-ins and protests to dwell on himself and his
losses.

Any time you can redirect your parent’s attention outward — even for a short time — you have made an inroad. Gently convince, cajole and persuade your parent to stay involved in the lives of family and friends, participate in a support group, or volunteer.

Recognizing Clinical Depression

Clinical depression is a deep melancholy that persists over weeks and months. It can become so severe that the senior’s health deteriorates as his ability for self-care becomes compromised.

A medical evaluation can determine whether illness or drug side effects are contributing to the problem. Once the doctor rules out those possibilities, he or she may suggest therapy with a trained therapist who can help the older adult gain a more optimistic view of life, enhance his coping
skills and put to rest things that have troubled your parent for decades.

Taking Medicine

Depression is an illness, not a character flaw. Don’t let your parent resist visiting the doctor for depression because he believes that he should be strong enough to overcome it himself.

Antidepressants for severe depression are effective in 80 percent of patients. Unfortunately, as discovered in a recent UCLA study, fewer than one in three depressed seniors had received treatment for their depression in the previous three months. Antidepressants generally take about two weeks to
begin to take effect, and it may be as many as four to six weeks before the elder feels better. In the meantime, therapy can help your parent learn more successful ways to deal with life’s problems. Most people do best on a combination of talk therapy and antidepressants. (In some cases, electroconvulsive therapy or “shock therapy” may be recommended. It sounds frightening, but nowadays it’s quick, effective and safe — and especially successful in treating elderly people whose depression doesn’t respond to any other treatment.)

Where to Turn for Help

Jewish Family Service (JFS) of Los Angeles operates five senior centers. All five offer counseling.

“We do not believe that depression is an inevitable part of aging,” said Karen Leaf, director of the JFS Valley Storefront Senior Center. “We feel that older adults who are depressed can greatly benefit from individual and group psychotherapy.”

JFS offers groups for widowers, seniors with difficult relationships with adult children, caregivers (who are at high risk for depression) and general for-men-only or for-women-only groups.

Leaf urges adult children to be aware of depressive signs and be willing to suggest counseling to a depressed aging parent. She advises children to “speak from the heart” with “I” statements. For example, “Mom, I have observed that you are very sad and are losing weight. There’s a Jewish
organization that can help. People need some help from time to time, and you have a lot of things on your plate.”

If your efforts to get your parent into treatment are unsuccessful, Leaf cautioned, “You have to let it go, because ultimately, unless their safety is at risk, there are boundaries that must be respected.”

For more information on Jewish Family Service, call (323) 761-8800, to find the nearest center. Sometimes Medicare will cover the fee. If not, don’t worry — JFS operates on a sliding-fee scale.

The Center for Healthy Aging (CHA) in Santa Monica also provides help to depressed seniors and their families. CHA’s services include individual psychotherapy, group therapy and medication management.

There’s also senior peer counseling — a model program that has been replicated throughout the United States and abroad.

The program trains volunteer senior peer counselors to help other older adults over the rough spots. Peer counseling is ideal for depressed seniors who need emotional support but may be uncomfortable with the idea of using mental health professionals and services, yet are willing to talk to
counselors they perceive as more like themselves (for example, widows and former caregivers).

If your parent lives on the greater Westside and is reluctant to call CHA, you may call Dr. Amy Liston, at (310) 576-2550 ext. 217. CHA provides supportive services to the adult child and their elderly parent. There is a sliding fee scale.

The Los Angeles Jewish Home for the Aging (JHA) employs geriatricians that are available to see their resident patients as frequently as necessary.

Laurie Manners, administrator of Grancell Village of JHA, explained that JHA works closely with a geropsychiatric group that provides both psychiatrists and psychologists. These mental health professionals address elder depression and other psychiatric needs for the JHA’s residents each week,
and are available for emergency services. Residents are helped using a variety of treatments (including behavior modification, one-on-one counseling, medication or a combination of these).

“We treat depression aggressively whether it comes from grieving, life events or transitions or other general living issues,” Manners said.

For more information about the Los Angeles Jewish Home for the
Aging call (818) 774-3306.

How to Recognize Clinical Depression

If your elder exhibits any of the following symptoms, he or she may be suffering from a clinical depression and should be seen by a physician:

  • Describes a feeling of “emptiness” or “hopelessness”
  • Shows lack of interest in everyday activities
  • No longer enjoys formerly pleasurable pastimes
  • Cries often, sometimes for no apparent reason
  • Complains about lack of concentration, faulty memory and trouble making decisions
  • Expresses feelings of worthlessness or guilt
  • Has thoughts of suicide or has made an attempt
  • Complains of headaches, backaches or stomachaches that don’t respond to treatment (when physical problems hide depression, the condition is called a masked depression)
  • Uses more alcohol, drugs and tobacco
  • Pays less attention to grooming and hygiene
  • Sleeps too little or too much, has trouble falling asleep and may wake up early, unable to fall asleep again
  • Appears tired and sluggish
  • Eats more or less than usual, resulting in significant
    weight gain or loss
  • Frequently becomes agitated, hostile, or disoriented
  • Adopts depressive positions and gestures (including sad
    facial expressions, being stooped over and staring across the room)

Dr. Rachelle Zukerman is professor emeritus at UCLA, a gerontologist, author of “Eldercare for Dummies” (Wiley Publishing) and a public speaker on aging issues. She can be reached at DrRZuk@aol.com.